Integrative medicine

Integrative medicine, which is also called integrated medicine and integrative health in the United Kingdom,[1] combines alternative medicine with evidence-based medicine. Practitioners claim that it treats the "whole person," focuses on wellness and health rather than on treating disease, and emphasizes the patient-physician relationship.[1][2][3][4]

Integrative medicine has been criticized for compromising the effectiveness of mainstream medicine through inclusion of ineffective alternative remedies,[5] and for claiming it is distinctive in taking a rounded view of a person's health.[6]

Definition

The Academic Consortium for Integrative Medicine and Health has developed the following definition: "Integrative medicine and health reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic and lifestyle approaches, healthcare and disciplines to achieve optimal health and healing.".[7] Advocates say that integrative medicine is not the same as complementary and alternative medicine (CAM)[1][8] nor is it simply the combination of conventional medicine with complementary and alternative medicine.[2] They say instead that it "emphasizes wellness and healing of the entire person (bio-psycho-socio-spiritual dimensions) as primary goals, drawing on both conventional and CAM approaches in the context of a supportive and effective physician-patient relationship".[2]

David Gorski has written that the term "integrative medicine" has become the currently preferred term for non-science based medicine.[9]

History

In the 1990s, physicians in the United States became increasingly interested in integrating alternative approaches into their medical practice, as shown by a 1995 survey in which 80% of family practice physicians expressed an interest in receiving training in acupuncture, hypnotherapy, and massage therapy.[10] In the mid-1990s hospitals in the United States began opening integrative medicine clinics, which numbered 27 by 2001.[10] The Consortium of Academic Health Centers for Integrative Medicine was founded in 1999 and by 2015 included 60 members, such as Johns Hopkins University School of Medicine, Duke University School of Medicine, Georgetown University School of Medicine, and Mayo Clinic. In 2015 it was renamed Academic Consortium for Integrative Medicine and Health. The goal of the Consortium is to advance the practice of integrative medicine by bringing together medical colleges that include integrative medicine in their medical education.[1][11][12] The American Board of Physician Specialties, which awards board certification to medical doctors in the U.S., announced in June 2013 that in 2014 it would begin accrediting doctors in integrative medicine.[13]

In order to objectively test alternative medicine treatments, in 1991 the U.S. government established the Office of Alternative Medicine, which in 1998 was re-established as the National Center for Complementary and Alternative Medicine (NCCAM) as one of the National Institutes of Health. In 2015, NCCAM was re-established as the National Center for Complementary and Integrative Health (NCCIH). The mission of NCCIH is "to define, through rigorous scientific investigation, the usefulness and safety of complementary and integrative interventions and to provide the public with research-based information to guide health-care decision making."[14]

Impetus

Medical professor John McLachlan has written in the BMJ that the reason for the creation of integrative medicine was as a rebranding exercise, and that the term is a replacement for the increasingly discredited one of "complementary and alternative medicine".[6]

Proponents of integrative medicine say that the impetus for the adoption of integrative medicine stems in part from the fact that an increasing percentage of the population is consulting complementary medicine practitioners. Some medical professionals feel a need to learn more about complementary medicine so they can better advise their patients which treatments may be useful and which are "ridiculous".[8] In addition, they say that some doctors and patients are unsatisfied with what they perceive as a focus on using pharmaceuticals to treat or suppress a specific disease rather than on helping a patient to become healthy. They take the view that it is important to go beyond the specific complaint and draw upon a combination of conventional and alternative approaches to help create a state of health that is more than the absence of disease.[2] Proponents further suggest that physicians have become so specialized that their traditional role of comprehensive caregiver who focuses on healing and wellness has been neglected.[1] In addition, some patients may seek help from outside the medical mainstream for difficult-to-treat clinical conditions, such as fibromyalgia and irritable bowel syndrome.[1]

Reception

Integrative medicine has been criticized for compromising the effectiveness of mainstream medicine through inclusion of ineffective alternative remedies,[5] and for claiming it is distinctive in taking a rounded view of a person's health.[15] The practice of Integrative medicine is sometimes lumped together with alternative medicine, which has received criticism and has been called "snake oil."[16][17] A primary issue is whether alternative practices have been objectively tested. In a 1998 article in The New Republic, Arnold S. Relman, a former editor of The New England Journal of Medicine stated that "There are not two kinds of medicine, one conventional and the other unconventional, that can be practiced jointly in a new kind of 'integrative medicine.' Nor, as Andrew Weil and his friends also would have us believe, are there two kinds of thinking, or two ways to find out which treatments work and which do not. In the best kind of medical practice, all proposed treatments must be tested objectively. In the end, there will only be treatments that pass that test and those that do not, those that are proven worthwhile and those that are not".[5]

McLachlan writes that it is an "insult" that integrative medical practitioners claim unto themselves the unique distinction of taking into account "their patients' individuality, autonomy, and views", since these are intrinsic aspects of mainstream practice.[15]

Steven Novella, a Neurologist at Yale School of Medicine, said that NCCIH's activities are "used to lend an appearance of legitimacy to treatments that are not legitimate".[16] The NCCIH website states that there is "emerging evidence that some of the perceived benefits are real or meaningful". NCCIH also says that "the scientific evidence is limited" and "In many instances, a lack of reliable data makes it difficult for people to make informed decisions about using integrative health care".[18]

A 2001 editorial in BMJ said that integrative medicine was less recognized in the UK than in the United States.[19] The universities of Buckingham and Westminster had offered courses in integrative medicine, for which they were criticized.[20][21][22] In the UK organizations such as The Prince's Foundation for Integrated Health, The College of Medicine[23] and The Sunflower Jam[24] advocate or raise money for integrative medicine.

In 2003 Michael H. Cohen argued that integrative medicine creates a "liability paradox," in that the greater the cross-disciplinary integration among providers, the greater the risk of shared liability among them; thus, "information sharing may expand liability but ultimately reduce risk to the patient; yet maintaining sharp boundaries between providers may decrease risk of shared liability but ultimately increase risk to the patient."[25] Steven Salzberg has criticized the teaching of integrative medicine in medical schools, especially the inclusion of Pseudoscientific subjects such as homeopathy.[26] In Salzberg's view in offering an integrative medicine course, the University of Maryland Medical School was "mis-training medical students".[26]

See also

References

  1. 1 2 3 4 5 6 Snyderman R, Weil AT (February 2002). "Integrative medicine: bringing medicine back to its roots". Arch. Intern. Med. 162 (4): 395–7. doi:10.1001/archinte.162.4.395. PMID 11863470.
  2. 1 2 3 4 Bell IR, Caspi O, Schwartz GE, et al. (January 2002). "Integrative medicine and systemic outcomes research: issues in the emergence of a new model for primary health care". Arch. Intern. Med. 162 (2): 133–40. doi:10.1001/archinte.162.2.133. PMID 11802746.
  3. ↑ Kam, Katherine. "What Is Integrative Medicine? Experts explore new ways to treat the mind, body, and spirit -- all at the same time". WebMD. Retrieved August 26, 2013.
  4. ↑ Complementary, Alternative, or Integrative Health: What’s In a Name? National Center for Complementary and Integrative Health. (Accessed 20 February 2011)
  5. 1 2 3 Arnold S. Relman, "A trip to Stonesville", The New Republic, Dec 14, 1998.
  6. 1 2 McLachlan JC (2010). "Integrative medicine and the point of credulity". BMJ (Feature) 341: c6979. doi:10.1136/bmj.c6979. PMID 21147748.
  7. ↑ "About". Consortium of Academic Health Centers for Integrative Medicine. Retrieved August 18, 2013.
  8. 1 2 Rees, Lesley; Weil, Andrew (January 20, 2001). "Integrated medicine: Imbues orthodox medicine with the values of complementary medicine". BMJ 322: 119–120. doi:10.1136/bmj.322.7279.119.
  9. ↑ Gorski D (26 September 2011). "Andrew Weil and 'integrative medicine': The ultimate triumph of quackery?". Science-Based Medicine. Retrieved April 2014.
  10. 1 2 Whorton, James (2004). Nature Cures: The History of Alternative Medicine in America. New York: Oxford University Press. pp. 298–99.
  11. ↑ "Consortium of Academic Health Centers for Integrative Medicine". Retrieved August 18, 2013.
  12. ↑ "Members". Consortium of Academic Health Centers for Integrative Medicine. Retrieved August 18, 2013.
  13. ↑ "Does Integrative Medicine Really Work?". Chicago Magazine. August 2013. Retrieved August 27, 2013.
  14. ↑ "National Center for Complementary and Integrative Health". National Institutes of Health.
  15. 1 2 McLachlan JC (2010). "Integrative medicine and the point of credulity". BMJ (Feature) 341: c6979. doi:10.1136/bmj.c6979. PMID 21147748.
  16. 1 2 Brown, David (17 March 2009). "Scientists Speak Out Against Federal Funds for Research on Alternative Medicine". The Washington Post.
  17. ↑ Kolata, Gina (June 17, 1996). "On Fringes of Health Care, Untested Therapies Thrive". New York Times. Retrieved August 28, 2013.
  18. ↑ "Complementary, Alternative, or Integrative Health: What's In a Name?". NCCIH, National Institutes of Health. Retrieved September 23, 2013.
  19. ↑ Rees, Lesley; Weil, Andrew (January 20, 2001). "Integrated medicine: Imbues orthodox medicine with the values of complementary medicine". BMJ 322: 119–120. doi:10.1136/bmj.322.7279.119.
  20. ↑ David Colquhoun (April 1, 2010). "University of Buckingham does the right thing. The Faculty of Integrated Medicine has been fired.". DC's Improbable Science.
  21. ↑ David Colquhoun (March 22, 2007). "Science degrees without the science" (PDF). Nature 446 (22): 373–4. doi:10.1038/446373a. PMID 17377563.
  22. ↑ Jim Giles (March 22, 2007). "Degrees in homeopathy slated as unscientific" (PDF). Nature 446 (22): 352–3. doi:10.1038/446352a.
  23. ↑ James May (12 July 2011). "College of Medicine: What is integrative health?". British Medical Journal 343: d4372. doi:10.1136/bmj.d4372. PMID 21750063.
  24. ↑ Jane Cassidy (15 June 2011). "Lobby Watch: The College of Medicine". British Medical Journal 343. doi:10.1136/bmj.d3712. PMID 21677014.
  25. ↑ Michael H. Cohen (2003). Future Medicine: Ethical Dilemmas, Regulatory Challenges, and Therapeutic Pathways to Health Care and Healing in Human Transformation. Univ. of Michigan Press. pp. 60–80.
  26. 1 2 Salzberg S (21 April 2011). "Why Medical Schools Should Not Teach Integrative Medicine". Forbes. Retrieved April 2014.

Further reading

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